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Guts appears during Alan's early training of surgery. He complains that he can no longer eat due to being full of "food", where he proceeds to show the inside of his mouth. Although disgusted by Guts, Alan uses this as an opportunity to wield his newly earned chainsaw. With it he is able to explore the innards past Guts' ribs, where he extracts various amounts of metal material. After clearing the junk out of him, Alan quickly bids Guts farewell so he can move on to his next patient.

Later on, after Alan and Bleed have saved the Crime Boss and his henchman, Guts enters into the operating room. He claims to have eaten a peculiar tasting sandwich, which was given to him by a "real pretty" girl. As Guts opens his mouth, a ticking sound can be heard, which is revealed to belong to a bomb when he is cut open. Thankfully with Alan's steady hands and Dr. Bleed's quick thinking, they were able to partially defuse it, removing it from Guts' insides.

The patient owns a junkyard where he appears to act both as a custodian and some kind of food disposal unit. Excess iron, copper, and other metals have been established in the patient's diet, causing great discomfort and a large quantity of gas, apparently. Scan patient to discover the source of the problem, operate and then explain the difference between a sandwich and a lump of metal.

At a time when there is a crazy person running around attacking and poisoning people, Guts has eaten an unidentified sandwich presented to him by a stranger...brilliant. The patient is ticking. It COULD be his healthy heartbeat though, right? Right, doc?

No, Alan, it's a bomb. -DR. Bleed

Open him up and find a way to defuse the situation, or we're going to be seeing Guts everywhere we look.

During his adventure through the circus, Alan follows Mileena Lamia in hopes of finding out who had sent him the distress note. There she introduces him and Bradley to the "Man-Eating Chicken", a man in a chicken suit literally eating pieces of chicken. After removing the various objects and chicken stuck inside his body, the man is revealed to be Guts. He explains to Alan that he was the sender of the note, hoping to receive help for him and his fellow circus-goers from Alan.

Guts appears as an obese man with grey hair and a stubble. In Amateur Surgeon, he wore a blue jumpsuit with a nametag and a matching cap. Later on in Circus Freak-Out, his hair has turned white as he's shown wearing a brown chicken suit. Guts displays a chummy demeanor and has a huge love for food. He's almost always shown holding a food item in his hand. He can be a bit dimwitted since he'll eat anything given to him whether if it's edible or not.

Here the player will have use the Chainsaw to cut out his ribs. When removed, the player must extract the little bone as normal, then use the etchy sketch to find the hidden magnet. After the player finds and extracts the magnet, it will cause a bunch of metal to appear, which must be extracted as well. Then the player will have patch up the wounds as normal, including the wound from the magnet. After that, all that is needed is to put the ribs back in place with the lighter and gel.

In AS4, all the bone and metal pieces, along with the magnet, are already exposed, so use of the scanner is not neccessary.

There's a whole lot of food covering the bomb inside Guts. Due to this, the player must use the tongs to lift up and remove them. In AS, the player will have to use the etchy sketch to find the correct order to cut the wires with the pizza cutter (this was changed in AS4, where the numbers are not only exposed, but the game will literally tell the player which wire they need to cut, which requires the chainsaw). After the wires are cut, the pins must be removed with the tongs, where the player will then be able to burn the fuses after all of them are removed. The player must use the lighter in a rubbing motion to burn the fuses, which are all marked with "3A". When all fuses are burnt, the player will be taken back to close up Guts.

This surgery can put a bunch of pressure on the player in AS4 due to the very short time limit. If the player is nervous about that, they might want to use Professor Rippov or Procrastibot 3000 to help save some time.

When making the first incision inside Guts, you'll find four objects sticking out from underneath the flesh. However they cannot be extracted until you enter in and slice off the flesh stuck on the end of the objects. When clear of all objects and wounds, you'll be able to cut in deeper into his intestines to find...more objects! Extract and patch up, then cut open his large intestine, where a whole bunch of chicken pieces await to be extracted. However, it's not over yet, for there are 4 hidden objects you'll need to find with the scanner and slice out to extract them. They'll leave behind poison you'll need to suck up with the syringe and vacuum up(absent in AS4.) Afterward Guts can be closed up.

In the Frostbite Freakout event in Amateur Surgeon 4, while named "Festive Guts", his power is similar to Filthy Nowe in terms of providing the player extra coins and shiny objects (while stuffed into a fruitcake, then the cake falls apart into slices) inside the patient.